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PubMed1996

Attempted transmission of Ehrlichia canis by Rhipicephalus sanguineus after passage in cell culture.

OBJECTIVES: To compare the transmissibility by the brown dog tick, Rhipicephalus sanguineus, of a recent isolate of Ehrlichia canis (Ebony) with that of another isolate (Oklahoma) that had been passaged in cell culture, and to assess the genetic similarity of the 2 isolates as reflected in the nucleotide (NT) sequence of 16S rDNA. ANIMALS: 13 healthy dogs of various ages and breeds. PROCEDURE: Larval and nymphal ticks were acquisition fed on acutely infected dogs, and, after molting, they were transmission fed as nymphs and adults, respectively, on Ehrlichia-naive dogs. All dogs were monitored daily by blood smear evaluation for evidence of parasitized leukocytes and by physical examination for clinical signs of ehrlichiosis. Serologic and hematologic values were measured weekly. Using a nested polymerase chain reaction, the 16S rDNA was amplified, and the NT sequence of the template DNA was determined. RESULTS: The Ebony isolate of E canis was successfully transmitted to dogs by nymphal and adult ticks. In contrast, no ticks that fed on dogs harboring the cell-cultured isolate (Oklahoma) transmitted it to dogs. On the basis of 16S rDNA sequence, the 2 isolates were 99.9% similar, with only 1 NT difference. CONCLUSIONS: These results reconfirm the vector potential of R sanguineus for E canis. Passage of the Oklahoma isolate of E canis in cell culture apparently adversely affected its transmissibility by ticks, raising the possibility that cell-cultured isolates of this rickettsia may lose their affinity for ticks. Determination of 16S rDNA sequence suggests minor strain variation within the species E canis.

Animals↗
PubMed2005

Effect of a mandatory geriatric medicine clerkship on third-year students.

A nationwide push has increased geriatric medicine instruction within medical school curricula. Some institutions have proceeded with an integrated 4-year curriculum while others have constructed discrete courses in the third or fourth year of medical school. This paper describes the impact of a new mandatory 4-week geriatric medicine clerkship on third-year students developed by the Donald W. Reynolds Department of Geriatric Medicine at the University of Oklahoma Health Sciences Center. In the first year of implementation, 135 students took the course on both the Oklahoma City and Tulsa campuses. Clinical sites included inpatient, VA extended care unit, outpatient clinics, dementia clinics, home care, long-term care settings, and hospice. Didactic instruction used formal lectures and problem-based learning. The impact of the clerkship on students was assessed in three areas: knowledge, skills, and attitude using a pre- and postknowledge test, student satisfaction survey, and written comments. This article discusses how the clerkship resulted in increased knowledge of geriatric medicine. Student self-report indicates that the clerkship enhanced clinical evaluation and patient assessment skills. Students indicated that the experience was positive and recognized the importance of geriatric medicine in their development as doctors.

Aged↗
PubMed1995

Prostate cancer screening. What family physicians believe is best.

OBJECTIVE: To determine current family physician beliefs concerning prostate cancer screening. DESIGN: Two hundred eighty-six Oklahoma family physicians were surveyed by mail. Fifty-three percent of physicians returned the questionnaire. Physicians were questioned on what tests they order for prostate screening, the reasons for ordering a serum prostate-specific antigen (PSA) test, what test results would cause a urologic referral for further evaluation of prostate cancer, and whether prostate cancer screening would decrease the patient's mortality or improve quality of life. RESULTS: Most physicians (74%) believed that both a digital rectal examination and a serum PSA determination are appropriate for prostate cancer screening. Physicians' primary reasons for ordering a PSA test were to decrease patient mortality and morbidity. Sixty-two percent of physicians believed that prostate cancer screening would decrease mortality and 69% agreed that screening would improve quality of life. Approximately 90% of physicians would refer patients with a PSA level greater than 12 micrograms/L or a PSA level of 5 micrograms/L and an indurated prostate. Significant variation was found between groups of physicians in their beliefs about prostate cancer screening. CONCLUSION: Although the literature has been inconclusive on the benefit of prostate cancer screening, the majority of Oklahoma family physicians would choose to screen their patients and believe that patients' mortality and morbidity are decreased by early identification of prostate cancer.

Adult↗
PubMed1995

Physician patterns in the provision of health care to their own employees.

OBJECTIVE: To determine the level of medical and mental health care that family physicians provide to employees. DESIGN: Mailed survey. SETTING: Family practices in Oklahoma. SUBJECTS: Two hundred ninety-one of 735 physicians assessed via the membership roster of the Oklahoma Academy of Family Physicians. RESULTS: The majority of physician respondents (55.6%) reported providing routine health care always or most of the time to employees. Rural practice sites were associated with the provision of broader medical services (Spearman's p = -.35, P < .00001); 51.7% of respondents reported providing routine health care always or most of the time to employees' families. Breast and genital examinations were more likely to be undertaken in family members (67.2%) compared with employees (50.0%). Only a minority of physician respondents (12.3%) reported providing mental health care always or most of the time to employees; 53% never or rarely provided this service. When mental health care was addressed, respondents provided counseling alone (28.6%), prescription of psychotropic medication alone (8.8%), or both (62.7%). Antidepressants (50.7%) and nonbenzodiazepine anxiolytic agents (36.2%) were most frequently prescribed. When asked about ideal conditions, a significant minority of physician respondents (41.3%) preferred to refer employees to colleagues for medical care, and 59.8% preferred to refer for mental health care. CONCLUSION: The majority of family physicians in this study reported providing medical care to their employees, whereas only a minority provide mental health care.

Drug Prescriptions↗
PubMed1998

Underuse of venous thromboembolism prophylaxis for general surgery patients: physician practices in the community hospital setting.

BACKGROUND: Venous thromboembolism is a common complication of surgery. Although surveys of physician self-reported practices have suggested near universal support for routine use of measures to prevent venous thromboembolism, medical record auditing has demonstrated underuse. OBJECTIVE: To assess physician practices of venous thromboembolism prophylaxis in the community hospital setting. METHODS: Retrospective review of the medical records from 20 hospitals in Oklahoma of 419 Medicare patients aged 65 years or older undergoing major abdominothoracic surgery between April 1 and December 31, 1995. Utilization rates of prophylaxis stratified according to patient risk for venous thromboembolism were measured. RESULTS: Prophylaxis measures were implemented for only 160 (38%) of 419 patients studied (95% confidence interval, 33%-43%). There was little variation in the use of prophylaxis based on the risk for venous thromboembolism. Only 97 (39%) of 250 patients (95% confidence interval, 33%-45%) at very high risk received any form of prophylaxis and of these 97, only 64 patients (66%) received appropriate measures (95% confidence interval, 56%-75%). CONCLUSIONS: Despite widely disseminated, evidence-based recommendations, venous thromboembolism prophylaxis is underused in Medicare patients undergoing major abdominothoracic surgery in community hospitals in Oklahoma.

Abdomen↗
PubMed1999

Effect of newborn screening for congenital adrenal hyperplasia.

OBJECTIVE: To compare the incidence of diagnosis and morbidity in newborns who were screened with newborns who were not screened for congenital adrenal hyperplasia (CAH). DESIGN: A retrospective cohort study. SETTING: Arkansas, Oklahoma, and Texas. PATIENTS: An unscreened population in Arkansas and Oklahoma (n = 400118) was compared with a screened population in Texas (n = 1613378) during a 5-year period. Simultaneous data were collected on the incidence of diagnosis and associated morbidity in patients with CAH. MAIN OUTCOME MEASURES: Diagnosis of CAH, age (in days) at diagnosis, and frequency and length of initial hospitalization. RESULTS: The incidence of diagnosis of classic CAH per 100000 newborns in the unscreened cohort (5.75) and in the screened cohort (6.26) was similar (relative risk, 0.92; 95% confidence interval, 0.58-1.44). The unscreened group had 0.73 fewer male newborns with salt-wasting CAH diagnosed per 100000 newborns (relative risk, 0.73; 95% confidence interval, 0.35-1.56). The median age at diagnosis was 26 days for male newborns with salt-wasting CAH in the unscreened cohort vs 12 days in the screened cohort (z = 2.49; P = .01). Male newborns with simple-virilizing CAH and newborns with nonclassic CAH were detected only in the screened cohort. CONCLUSIONS: There was not a statistically significant (P = .73) increase in the diagnosis of salt-wasting CAH in the screened cohort. Male newborns benefited as a result of significantly (P = .01) earlier diagnosis, reduced morbidity, and shorter lengths of hospitalization. Large collaborative studies or meta-analyses are needed to determine the life-saving benefits of screening.

17-alpha-Hydroxyprogesterone↗
PubMed1984

Neighborhood variations in the use of hospital emergency rooms for primary care.

The purpose of the paper is to analyze neighborhood variations in the use of emergency rooms (ERs) as settings for primary care within Oklahoma County, part of the Oklahoma City MSA. The location of patients taken from a sample of ER records in four large hospitals were aggregated to census tracts. Tract visitation rates were estimated and related to the socio-economic character and the relative location of the tracts for two periods--'physicians' office hours' and 'non-office hours'. The results show that for the city as a whole primary care use in emergency rooms is associated with the socio-economic status and relative location of a residential area. Tracts with lower socio-economic status have higher rates of emergency rooms use for primary care than those of higher status. This relationship is true both during physicians' office hours as well as during the times their offices are closed. When visitation rates are analyzed separately for individual hospitals, location rather than neighborhood socio-economic characteristics is paramount. It was concluded that while primary care visits to emergency rooms are higher in lower socio-economic status neighborhoods, and that this is a function of the more accessible location of emergency rooms to these neighborhoods as well as to socio-economic effects on use.

Appointments and Schedules↗
PubMed1990

Kerr-McGee and the NRC: from Indian country to Silkwood to Gore.

By focusing upon the Nuclear Regulatory Commission's appraisal of the Kerr-McGee Corporation's safety record in the Four Corners area and at two facilities in Oklahoma, this article examines the political economy of nuclear regulation in American society. Particular attention is given to the agency's response to intervenor groups which protested various operations at Kerr-McGee facility in Gore, Oklahoma, both prior to and following the accidental rupture of a cylinder containing uranium hexafluoride. Despite a consistent record of violations and nuclear mishaps by Kerr-McGee, the Nuclear Regulatory Commission permitted the company to essentially monitor its own activities. Rather than protecting workers and the public from the hazards of the nuclear industry, state regulation attempts to legitimize and defuse public opposition to its endeavors.

Accidents, Occupational↗
PubMed1984

The trichostrongylid egg output during spring in feedlot cattle.

Larval cultures prepared from faeces collected at two-week intervals from feeder cattle originating from Michigan, Oklahoma and Kentucky, and kept in a feedlot in Michigan, were examined during the winter and spring of 1979. The animals received anthelmintic treatment shortly after entering the feedlot. The larval output, consisting mainly of Ostertagia larvae, was less than 20 larvae per g, but did show a seasonal increase during spring in the cattle originating from Kentucky and Michigan. This "spring rise" was not observed in the animals originating from Oklahoma which is thought to be related to a difference in transmission pattern of Ostertagia in the southwest as compared to the eastern and midwestern parts of the U.S.A.

Animal Husbandry↗
PubMed2005

Disciplinary action against physicians: who is likely to get disciplined?

PURPOSE: We sought to determine the characteristics of disciplined physicians at-large and the risk of disciplinary action over time and to report the type and frequency of complaints and the nature of disciplinary actions against allopathic physicians in Oklahoma. METHODS: Descriptive statistics, Kaplan-Meier analysis, and Cox proportional hazards modeling of publicly available data on physicians licensed by the Oklahoma Board of Medical Licensure and Supervision. RESULTS: Among 14,314 currently or previously licensed physicians, 396 (2.8%) had been disciplined. Using univariate proportional hazards analysis, men (P <0.04), non-whites (P < 0.001), non-board-certified physicians (P < 0.001), and those in family medicine (P < 0.001), psychiatry (P < 0.001), general practice (P < 0.001), obstetrics-gynecology (P < 0.03) and emergency medicine (P < 0.001) were found to be at greater risk of being disciplined than other medical specialty groups. Foreign medical graduates had a higher risk of disciplinary action compared to US medical graduates (P < 0.001), although this finding was not confirmed by multivariate analysis. Kaplan-Meier analysis revealed that the proportion of physicians disciplined increased with each successive 10-year interval since first licensure. Complaints against physicians originated most often from the general public (66%), other physicians (5%), and staff (4%), and the complaints most frequently involved issues related to quality of care (25%), medication/prescription violations (19%), incompetence (18%), and negligence (17%). CONCLUSION: To improve physician behavior and reduce the need for disciplinary action, medical schools and residency training programs must continue to emphasize both patient care and medical professionalism as critical core competencies.

Employee Discipline↗
PubMed2005

Impact of core and secondary foods on nutritional composition of diets in Native-American women.

OBJECTIVE: To identify the core and secondary foods among Native-American women in Oklahoma and to determine their impact on nutrient and Food Guide Pyramid serving intakes. DESIGN: This descriptive study explored food intakes from 4-day weighed food records. Nutrient intakes were estimated using reference data used in national survey data. SUBJECTS/SETTING: Seventy-one Native-American women receiving services from three tribal health clinics in northeast Oklahoma. Statistical analyses performed A food-use frequency score was computed using frequencies of individuals consuming foods across each of 4 days of records. Leading contributors of nutrients and Food Guide Pyramid servings were identified from core and secondary foods. RESULTS: Thirty foods comprised the list of core foods, led by soda, coffee, and white bread. A majority of total energy, fat, saturated fat, monounsaturated fatty acids, polyunsaturated fatty acids, cholesterol, carbohydrate, calcium, vitamin C, folate, discretionary fat, and added sugar were derived cumulatively from the core and secondary foods. Forty percent of fruit Food Guide Pyramid servings were accounted for by two core foods, bananas, and orange juice. More than half of meat and vegetable Food Guide Pyramid servings were derived from core and secondary foods. CONCLUSIONS: Food patterning data are helpful in the development of effective nutrition education programs. We identified less nutrient-dense core foods that are contributing to discretionary fat and added sugar intakes. Targeted nutrition education programs for Native Americans should promote the nutrient-dense core and secondary foods, such as whole-wheat bread and fruit, while providing more healthful food alternatives to less nutrient-dense foods.

Adolescent↗
PubMed2005

Dietary sources of nutrients among rural Native American and white children.

OBJECTIVE: To identify important food sources of energy, fiber, and major macro- and micronutrients among rural Native American and white children. DESIGN: In a 1997 cross-sectional study, food frequency questionnaire data were collected during in-person interviews with caregivers of young children. SUBJECTS/SETTING: Participants included a representative sample of 329 rural Native American and non-Hispanic white children aged 1 through 6 years living in northeastern Oklahoma. STATISTICAL ANALYSES: The percentage that each of 85 food items contributed to the population intake of 10 dietary constituents was calculated for the total sample and by age and race/ethnicity. Percentages are presented in descending rank order for foods providing at least 2% of the total sample intake. Z scores were used to assess age and racial/ethnic differences in food sources. RESULTS: Primary energy sources among study children were milk, cheese, white breads, salty snacks, nondiet soft drinks, hot dogs, candy, and sweetened fruit drinks. Diets showed poor food variety. With few exceptions (eg, milk, cheese, 100% orange juice, ready-to-eat cereals, peanuts/peanut butter, and dried beans), top sources of most dietary constituents were low-nutrient-dense high-fat foods and refined carbohydrates. Solid fruits and vegetables contributed minimally to nutrient and fiber intake. There were few differences in food sources by age or race/ethnicity. CONCLUSIONS: Among rural Native American and white children in northeastern Oklahoma, food sources of nutrients appear less healthful than found in national samples. Sugar-sweetened beverages, high-fat foods, and refined carbohydrates are displacing more nutrient-dense alternatives, increasing children's risk for childhood obesity, type 2 diabetes, and adult chronic disease.

Child↗
PubMed1997

The spectrum of pediatric injuries after a bomb blast.

The spectrum of pediatric injuries seen after a bomb blast is poorly documented. The pathophysiology of blast injuries differ significantly from other forms of trauma and typically result in large numbers of distinctly patterned injuries. On April 19, 1995, a truck bomb was detonated directly adjacent to the Alfred P. Murrah Federal Building in Oklahoma City, Oklahoma. A total of 816 adults and children were injured or killed as a direct result of the blast. Twenty infants and children were seated by the window of the second floor day care center at the time of the explosion. The injuries incurred by all children involved in the blast were studied. Nineteen children, 16 of whom were in the day care center, died as a direct result of the blast. The injury patterns among the 19 dead children included a 90% (17 of 19) incidence of skull fractures, 15 of those with cerebral evisceration (skull capping); 37% with abdominal or thoracic injuries; 31% amputations; 47% arm fractures, 26% leg fractures; 21% burns; and 100% with extensive cutaneous contusions, avulsions, and lacerations. Forty-seven children sustained nonfatal injuries with only seven children requiring hospitalization. The injuries sustained by the seven hospitalized children included two open, depressed skull fractures, with partially extruded brain, two closed head injuries, three arm fractures, one leg fracture, one arterial injury, one splenic injury, five tympanic membrane perforations, three corneal abrasions, and four burn cases (1 > 40% body surface area [BSA]). After a bomb blast, pediatric patients sustain a high incidence of cranial injuries. Fractures and traumatic amputations are common. Intraabdominal and thoracic injuries occur frequently in the deceased but infrequently in survivors.

Adolescent↗
PubMed1987

Transmission of invasive Haemophilus influenzae type b disease in day care settings.

We prospectively studied the risk of secondary transmission of invasive Haemophilus influenzae type b (Hib) disease among children in day care in Oklahoma. We established a statewide surveillance system for the reporting of all forms of invasive Hib disease from physicians, clinical laboratories, county health departments, and infection control practitioners from all hospitals in and bordering Oklahoma. For the 2-year period March 15, 1984, to March 15, 1986, there were 409 culture-confirmed cases of invasive Hib disease in children 12 years of age or younger; 147 (37%) case-patients attended day care. When a case-patient attended day care during the week before illness, we prospectively identified and observed all classroom contacts (n = 2147) for the next 60 days. Of 1253 classroom contacts younger than 4 years of age, seven (0.6%) secondary cases were identified. Isolates from all paired index and secondary cases had identical outer membrane protein (OMP) patterns. Strains causing primary disease were indistinguishable by OMP distribution from those causing secondary disease. Of 685 classroom contacts younger than 2 years of age from whom rifampin use was ascertained, five (1.7%) of 292 who did not receive rifampin became secondary cases, compared with one (0.3%) of 393 who received rifampin (rate ratio 6.7; 95% confidence limits 1.1, 42.5; P less than 0.05). Of 495 classroom contacts 24 to 47 months of age for whom rifampin use was ascertained, one (0.5%) of 194 who did not receive rifampin became a secondary case, compared with none of 301 who received rifampin. This experience indicates that secondary transmission of invasive Hib disease can be appreciable in day care settings, particularly in children younger than 2 years of age, and that rifampin prophylaxis reduces this risk.

Child↗
PubMed2003

Therapeutic apheresis services provided by a community blood bank.

Therapeutic apheresis services can be provided from a community-based blood center. The Oklahoma Blood Institute uses a mobile approach, primarily servicing 10 major hospitals in the Oklahoma City metropolitan area within a 15 to 20 mile radius. Apheresis staff and equipment are available 24 hours per day, 7 days per week in the event of patient referral requiring an emergency therapeutic apheresis procedure. This model requires close communication between the therapeutic apheresis medical director and the referring clinician. Telephone and facsimile transmissions of information are used to facilitate the transfer of information to all persons/facilities involved in providing treatment. This approach has proven effective in providing the required procedures for a referral population base of several million people spread over a fairly large geographic area.

Ambulances↗
PubMedDate not supplied

Get off the bus: sound strategy for injury prevention during a tornado?

INTRODUCTION: On 08 May 2003, a tornado categorized as an F-3 on the Fujita Tornado Scale (the "F Scale") struck an Oklahoma City, Oklahoma commuter bus carrying 24 passengers. The driver evacuated several passengers before the tornado struck. The tornado rolled the bus, and pelted it with debris. METHODS: A case-series investigation of tornado-related injuries was conducted among passengers who were evacuated to a ditch and those who remained on the bus when the tornado struck. RESULTS: Nineteen of 24 passengers sought care for injuries at hospital emergency departments (injury rate = 79.2%). While a greater number of passengers who were outside the bus when the tornado struck (11) sought care for injuries than did those who remained on the bus (8); passengers outside of the bus suffered fewer injuries than did those who remained on the bus (median number of injuries 3 versus 4), and their injuries were less severe (median injury severity score (ISS) 1 versus 4). CONCLUSION: For persons caught in motor vehicles during tornado events, this study supports currently accepted recommendations to immediately evacuate and lie in a low-lying area away from motor vehicles if other shelter is unavailable. However, generalizing the experience of bus passengers to automobile drivers might be inappropriate because buses lack the safety features that might protect automobile drivers from tornado-related injuries.

Adolescent↗
PubMed1999

The use of patient mix-adjusted control charts to compare in-hospital costs of care.

We introduce a technique for patient mix-adjusting x charts and compared differences between unadjusted and patient mix-adjusted results. Our data came from coronary artery bypass graft (CABG) surgery patients at Baptist Medical Center, Oklahoma City, Oklahoma. We first developed an unadjusted x control chart to compare monthly changes in CABG surgery costs and then used a published model to patient mix-adjust our x control chart information. Before adjustment, the average log costs for three of ten months were outside the 90% control limit lines, and there was a trend toward increasing costs. After adjustment, two months had average costs outside the 90% lower control limit lines, and the trend toward increasing costs had been explained by differences in patient acuity.

Accounting↗
PubMed2003

Media exposure in children one hundred miles from a terrorist bombing.

This study assessed indirect interpersonal exposure to the 1995 Oklahoma City bombing, broadcast and print media exposure in the aftermath of the explosion, emotional reactions to media coverage, and posttraumatic stress reactions in children distant from the explosion. A survey was administered to 88 sixth-grade students in the public middle school in a community 100 miles from Oklahoma City 2 years after the bombing. Many children reported indirect interpersonal exposure and most reported bomb-related media exposure. Print media exposure was more strongly associated with enduring posttraumatic stress than broadcast exposure. Indirect interpersonal exposure and the interaction of media exposure with emotional reaction to media coverage in the aftermath of the explosion each predicted ongoing posttraumatic stress. The results suggest that children may have lingering reactions to highly publicized terrorist incidents. Concern about the influence of television viewing has long been proclaimed. This study implicates print media exposure as well. Media exposure to terrorist incidents, therefore, should be monitored and those working with children should assess exposure and stress even in children not directly impacted.

Child↗